The primary role of the authorization specialist is to obtain insurance authorization and to maximize reimbursement for services rendered.

DUTIES AND RESPONSIBILITIES:

• Follow-up with insurance companies to complete authorizations
  • Ensure all information was submitted
  • Complete Verbal Auth Forms for new treatment requests
  • Compare treatment plans with approved hours to ensure the correct hours were given
• Manage, track, and update authorized hours for clients
• Monitor authorization expiration dates to ensure treatment plans are submitted in a timely manner.
  • Identify barriers to obtaining appropriate and timely service authorizations and report to manager.
• Send authorization updates to BCBAs
  • Include breakdown of hours received
  • Notes for the next re-assessment period.
• Schedule Peer Reviews with BCBAs and insurance companies
• Send authorization reminders to BCBAs each month to ensure all authorizations are completed in a timely manner.
• Input authorization information into Central Reach for billing purposes.
• Utilize reports to ensure that all services are authorized.
• Review converted timesheets for the previous day for all codes and different levels of therapists.
  • Ensure correct procedure coding is used per time sheet and by all different levels of therapists.
  • Check conversion times against the sign-in sheet and the schedule to ensure all timesheets were entered and converted.
  • Check the locations of the timesheets to match the location of the appointment
  • Check for overlaps and duplicate appointments
  • Resolve and/or communicate any discrepancies
• Ensure Magellan/TriCare hours do not exceed the threshold
• Assist in collecting, posting, and monitor patient accounts

• Recognize problems and communicates them to appropriate personnel. 
• Performs other duties as assigned by administrator/ office manager.